ICYMI. I had no idea what this acronym meant when I first started out on Twitter (now X), but it is now one of my favorites to use. “In Case You Missed It” is a great way to bring attention to something that may have flown under the radar amid some other high-profile news story, like a Taylor Swift and Travis Kelce sighting, but that you believe the reader will care about.
Along these lines, ICYMI while you were enjoying your holiday celebrations, gatherings of family and friends, and ringing in the new year, ACP released two important new policy papers to help build upon our advocacy over the course of 2024 and beyond: “Ensuring Equitable Access to Participation in the Electoral Process” and “Principles for the Physician-Led Patient-Centered Medical Home and Other Approaches to Team-Based Care” were published Dec. 26, 2023, by Annals of Internal Medicine.
We are heading into a major election year. Of course, there is the presidential election, where at this point the two front-runners are battling concerns about their age as younger candidates try to make traction on the ballot. Additionally, Congress is being faced with a slew of retirements, with nine incumbents (as of this writing) announcing that they will not run again, which is more than any similar cycle over the past decade. The top issues at hand are also extremely contentious and complex, including abortion, Israel, China, climate change, gun violence, labor and unions, Medicare, transgender rights, the war in Ukraine, and more.
Yet another issue is whether the public will be able to access the polls in an equitable manner across the country. In the previous presidential election year, the country saw significant issues with voting access. Barriers to voting include but are not limited to a lack of identification documents, frequent changes of address, level of English proficiency, transportation challenges, limited polling hours and locations, and closures of registration offices due to emergencies such as COVID-19.
When it comes to physicians and other health care professionals, this problem is also compounded by lack of time off to vote, the belief that their vote does not have an impact, logistical challenges, and not registering in the location where they are training or practicing. Underlying structures in the electoral system, such as the drawing of state and federal electoral districts, also impact the weight one's vote carries.
Following the 2020 elections, nearly half the country took steps to limit access to voting, while the other half took steps to expand it. For example, in Iowa, nine days of early voting were eliminated; in New Hampshire, ballot drop boxes were removed; and in Georgia, providing water to voters waiting in line was criminalized. Overall, the Center for Public Integrity has found that, “160 million Americans live in the states reducing equity, and 151 million live in the places expanding it. About 20 million Americans live in the states where the situation did not change substantially.”
Gerrymandering, defined as the process of redrawing of electoral districts to intentionally give one party or group an advantage over another, is another way that voter access has been limited. The U.S. Supreme Court is currently considering a case about redrawn congressional maps in South Carolina that have been called “racial gerrymandering.” Both sides in this case are hoping it is decided by the beginning of 2024, in time for this upcoming election. If you are curious about how your state fares in terms of the drawing of electoral districts, the Princeton University Gerrymandering Project has constructed a “Redistricting Report Card” that is regularly updated.
Given concerns over the issue of gerrymandering, the ACP Board of Regents adopted a fall 2022 Board of Governors resolution that called for ACP to “adopt policy recognizing political gerrymandering as a significant public health problem.” ACP's Health and Public Policy Committee then took this issue on and determined that such a policy should be even more expansive to address not only gerrymandering but also other issues related to equitable access to the electoral process. Therefore, in this recent paper, the College acknowledges that voting impacts both health and health care, with the electoral processes and health being directly and indirectly linked.
For instance, the Cost of Voting Index (COVI) is a measure created in 2016 to assess the relative cost of voting in each state based on the time and effort required to cast a vote. States with lower COVI scores, indicating low barriers to voting, have better health outcomes than those with higher scores. ACP's new paper also calls for policies that ensure safe and equitable access to voting and for the removal of barriers to both the process of voter registration and the act of casting a vote; supports the drawing of fair, representative, and nonpartisan electoral districts; encourages medical students, residents, physicians, and other health care professionals to vote and supports efforts to eliminate barriers to their participation in the electoral process; and encourages nonpartisan health care-sponsored voter engagement as a strategy to increase health equity for patients and health care professionals. As the year progresses, keep an eye out for additional actions that ACP will take to help implement these important policies during this critical election year.
Beyond the federal elections, a significant amount of policy is being legislated at the state level, including on issues such as abortion, gender-affirming care, and scope of practice. With regard to the issue of scope of practice, ACP's new paper, “Principles for the Physician-Led Patient-Centered Medical Home and Other Approaches to Team-Based Care,” has updated our policy to state that “physicians have extensive education, skills, and training that make them most qualified to exercise advanced clinical responsibilities within teams” and goes on to state that we oppose “permitting nurse practitioners, physician assistants or other allied health professionals to engage in the independent practice of medicine.” ACP encourages our state chapters and members to use this updated policy in their state-level advocacy efforts.
To assist in these efforts, the College has updated our state health policy toolkit on scope of practice to reflect our policy and the latest efforts at the federal and state level in this area. Additionally, ACP state chapter leaders can reach out to the Governmental Affairs staff for assistance as needed, including to conduct a grassroots action alert regarding state-based legislation.
This latest ACP paper does more than simply update our policy regarding scope of practice. It also updates our policies regarding team-based care more broadly, as well as the patient-centered medical home. This includes affirming that physicians should have primary leadership responsibilities for health professionals working together in a multidisciplinary team-based care model and that patients should have access to an internal medicine or other physician trained in primary care to deliver whole-person, comprehensive, and longitudinal care, consistent with the Joint Principles of the Patient-Centered Medical Home, released in 2007 by ACP, the American Academy of Family Physicians, the American Academy of Pediatrics, and the American Osteopathic Association.
The College further recommends that assignment of specific clinical and coordination responsibilities for a patient's care within a collaborative and multidisciplinary clinical care team should be based on what is in the best interest of the patient; that all health professionals, administrators, and other key entities refrain from using the term “provider” and refer to health care professionals by the professional title in which they are credentialed and licensed; that a cooperative approach, including physicians, advanced practice registered nurses, other registered nurses, physician assistants, clinical pharmacists, and other health care professionals in collaborative team models, such as the patient-centered medical home, will be needed to address physician shortages; and that each team member who takes on responsibility to care for the patient must accept an appropriate level of associated liability.
Additionally, building on our other recent policies regarding physician payment, this paper reaffirms that health care delivery and payment be redesigned to support physician-led, team-based care delivery models, including but not limited to patient-centered medical homes and patient-centered medical home neighbor practices, in providing effective, patient- and family-centered care.
So, ICYMI, ACP has been keeping on top of the key issues that will impact you and your patients in the coming year. We look forward to sharing more as the year progresses and engaging chapter leaders and our members at large in these efforts. I invite all of you to spread the word about this just “in case” others out there “missed it” during the recent holiday season.